RESEARCH ARTICLE
Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city Golam Sarower Bhuyan1, Mohammad Amir Hossain1, Suprovath Kumar Sarker2, Asifuzzaman Rahat1, Md Tarikul Islam2, Tanjina Noor Haque1, Noorjahan Begum2, Syeda Kashfi Qadri3, A. K. M. Muraduzzaman4, Nafisa Nawal Islam2, Mohammad Sazzadul Islam1, Nusrat Sultana1, Manjur Hossain Khan Jony4,5, Farhana Khanam6, Golam Mowla7, Abdul Matin8, Firoza Begum9, Tahmina Shirin4, Dilruba Ahmed6, Narayan Saha10, Firdausi Qadri1,6, Kaiissar Mannoor1,2*
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OPEN ACCESS Citation: Bhuyan GS, Hossain MA, Sarker SK, Rahat A, Islam MT, Haque TN, et al. (2017) Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city. PLoS ONE 12(3): e0174488. https://doi.org/10.1371/journal. pone.0174488 Editor: Oliver Schildgen, Kliniken der Stadt Ko¨ln gGmbH, GERMANY Received: December 24, 2016 Accepted: March 9, 2017 Published: March 27, 2017 Copyright: © 2017 Bhuyan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.
1 Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh, 2 Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh, 3 Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore, 4 Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh, 5 Department of Virology, Mymensingh Medical College, Dhaka, Bangladesh, 6 Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh, 7 Department of Pediatrics, Suhrawardy Medical College Hospital, Dhaka, Bangladesh, 8 Department of Child Health, Dhaka Medical College Hospital, Dhaka, Bangladesh, 9 Department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 10 Pediatric Neurology, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh * [email protected]
Abstract The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection
PLOS ONE | https://doi.org/10.1371/journal.pone.0174488 March 27, 2017
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Acute respiratory infections in under-5 children in Dhaka
rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1–5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P
Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city Golam Sarower Bhuyan1, Mohammad Amir Hossain1, Suprovath Kumar Sarker2, Asifuzzaman Rahat1, Md Tarikul Islam2, Tanjina Noor Haque1, Noorjahan Begum2, Syeda Kashfi Qadri3, A. K. M. Muraduzzaman4, Nafisa Nawal Islam2, Mohammad Sazzadul Islam1, Nusrat Sultana1, Manjur Hossain Khan Jony4,5, Farhana Khanam6, Golam Mowla7, Abdul Matin8, Firoza Begum9, Tahmina Shirin4, Dilruba Ahmed6, Narayan Saha10, Firdausi Qadri1,6, Kaiissar Mannoor1,2*
a1111111111 a1111111111 a1111111111 a1111111111 a1111111111
OPEN ACCESS Citation: Bhuyan GS, Hossain MA, Sarker SK, Rahat A, Islam MT, Haque TN, et al. (2017) Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city. PLoS ONE 12(3): e0174488. https://doi.org/10.1371/journal. pone.0174488 Editor: Oliver Schildgen, Kliniken der Stadt Ko¨ln gGmbH, GERMANY Received: December 24, 2016 Accepted: March 9, 2017 Published: March 27, 2017 Copyright: © 2017 Bhuyan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.
1 Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh, 2 Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh, 3 Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore, 4 Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh, 5 Department of Virology, Mymensingh Medical College, Dhaka, Bangladesh, 6 Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh, 7 Department of Pediatrics, Suhrawardy Medical College Hospital, Dhaka, Bangladesh, 8 Department of Child Health, Dhaka Medical College Hospital, Dhaka, Bangladesh, 9 Department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 10 Pediatric Neurology, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh * [email protected]
Abstract The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection
PLOS ONE | https://doi.org/10.1371/journal.pone.0174488 March 27, 2017
1 / 21
Acute respiratory infections in under-5 children in Dhaka
rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1–5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P
